MEDICARE: BURGUNDY MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician
2	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1417765140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURGUNDY MEDICAL PC

Provider Business Mailing Address
First Line	:	8304 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4566
Country	:	US
Telephone Number	:	347-492-0353
Fax Number	:	347-492-0203

Provider Business Practice Location Address
First Line	:	8304 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4566
Country	:	US
Telephone Number	:	347-492-0353
Fax Number	:	347-492-0203

Authorized Official
Title or Position	:	OWNER
Name	:	ALCIBIADES J. RODRIGUEZ
Credential	:	MD
Telephone Number	:	646-558-0800

Provider Enumeration Date	:	12/27/2024
Last Update Date	:	12/27/2024

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Directions to “BURGUNDY MEDICAL PC ” Practice Location

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